ArticleGastro hep advances2026
The Cardiovascular Risk Paradox in Normal-Weight Steatotic Liver Disease Beyond Body Mass Index-Based Detection.
Article in Gastro hep advances, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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14 authors.
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Abstract
Background and Aims: Cardiovascular screening largely relies on anthropometric metrics and overlooks normal-weight individuals with metabolic dysfunction, particularly those with steatotic liver disease (SLD). This gap may leave a substantially high-risk population undetected. Therefore, this study assessed the prevalence of cardiovascular disease (CVD) across 4 distinct metabolic phenotypes defined by body mass index (BMI) and hepatic steatosis status. Methods: We analyzed 34,848 Japanese adults enrolled in a community health screening program (2007-2010). Participants were classified into 4 metabolic phenotypes based on BMI and steatosis using the fatty liver index. The primary outcome was prevalent CVD. Logistic regression and machine learning models were used to compare the cardiovascular risk across phenotypes. Results: Normal-weight individuals with SLD (NWSLD; n = 496, 1.4%) demonstrated the highest CVD prevalence (3.63%) vs healthy controls (0.72%) and obese individuals with SLD (1.76%). After multivariable adjustment, NWSLD remained strongly associated with CVD (odds ratio: 3.63; 95% confidence interval: 2.11-5.88; Conclusion: NWSLD represents an unrecognized yet highly vulnerable cardiovascular phenotype, challenging BMI-centric risk assessment and supporting metabolic-based precision screening.
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